Arthritis

Editor’s Choice
Academic Journal
Main Category: Arthritis / Rheumatology
Also Included In: Anxiety / Stress;  Depression
Article Date: 30 Apr 2012 – 12:00 PDT

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3.5 (2 votes)

Approximately one third of adults with arthritis in the USA aged 45+ years suffer from anxiety or depression, researchers from the CDC reported in the journal Arthritis Care Research. The authors added that the prevalence of anxiety in adults with arthritis is almost twice as high as depression, in spite of more studies focusing on the arthritis-depression link.

27 million patients aged 25+ years have been diagnosed with osteoarthritis, and another 1.3 million with rheumatoid arthritis, according to data US health authorities. The CDC (Centers for Disease Control and Prevention) estimates that approximately 50 million people are affected by arthritis in the USA. The illness is the leading cause of disability in the country.

According to prior research, depression is common among patients with arthritis and other chronic illnesses and conditions. However, researchers and health care professionals have long been saying that anxiety among people with arthritis is common, under-treated and under-recognized. Until recently, anxiety was not taken into consideration as a depression risk-factor.

Team leader, Dr. Louise Murphy, who works at the Arthritis Program at the CDC, Atlanta, Georgia, and colleagues gathered data on participants of the CDC’s Arthritis Conditions and Health Effects Survey. The researchers say the sample is representative of people around the USA with arthritis symptoms who are aged at least 45 years. They identified 1,793 patients who had been diagnosed with arthritis or some other rheumatic condition.

They used the Arthritis Impact Measurement Scales to assess anxiety and depression in the participants.

They found that:

  • 31% of arthritis patients suffered from anxiety
  • 18% of arthritis patients suffered from depression
  • One third of the participants suffered from at least one of the two conditions – anxiety and/or depression
  • 84% of arthritis patients who had depression said they also had anxiety

Only half of those with depression or anxiety got medical help for their anxiety or depression during the previous twelve months.

Dr. Murphy said:

“Given their high prevalence and the effective treatment options that are available, we suggest that all people with arthritis be screened for anxiety and depression. With so many arthritis patients not seeking mental health treatment, health care providers are missing an intervention opportunity that could improve the quality of life for those with arthritis.”

Written by Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

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‘Arthritis – Anxiety Twice As Common As Depression’

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Keeping The Immune System Under Control With Stem Cell Therapy

Main Category: Immune System / Vaccines
Also Included In: Stem Cell Research;  Arthritis / Rheumatology
Article Date: 30 Apr 2012 – 0:00 PDT

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A new study, appearing in Cell Stem Cell and led by researchers at the University of Southern California, outlines the specifics of how autoimmune disorders can be controlled by infusions of mesenchymal stem cells.

Mesenchymal stem cells (MSC) are highly versatile stem cells that originate from the mesoderm, or middle layer of tissue, in a developing embryo. MSC can be isolated from many different kinds of human tissue, including bone marrow and the umbilical cord.

Principal investigator Songtao Shi, professor at the Ostrow School of Dentistry of USC Center for Craniofacial Molecular Biology, said that recent studies have shown the benefits of administering MSC to patients with immune-related disorders such as graft versus host disease, systemic lupus erythematosus, rheumatoid arthritis, and more.

These studies showed that infusions of MSC appeared to quell the production and function of overactive immune cells, including T- and B-lymphocytes. However, the specific mechanism behind how MSC get the immune cells under control hasn’t been fully understood.

“Mesenchymal-Stem-Cell-Induced Immunoregulation Involves FAS-Ligand-/FAS-Mediated T Cell Apoptosis” shines light on how infused MSCs target and defeat overactive immune cells. Examining the effects of MSC infusion in mice with systemic sclerosis (SS)-like immune disorders, Shi and his colleagues discovered that a specific cellular mechanism known as the FAS/FAS-ligand pathway was the key to the remarkable immune system benefits.

Specifically, in mice with SS-like disorders, infusions of MSC caused T-lymphocyte death with FASL/FAS signaling and lessened symptoms of the immune disorder. However, MSC deficient in FAS-ligand failed to treat immune disorders in SS-afflicted mice.

With the hopeful results of the animal model study in mind, Shi’s colleagues in China performed a pilot study with patients suffering from systemic sclerosis. Infusions of MSCs provided similar clinical benefits to patients, and experimental analysis revealed that the FASL/FAS pathway was also at work in humans with SS.

The identification of the cellular workings responsible for the stem cell treatments’ success may eventually help doctors find optimal cell-based treatment for some immune diseases, Shi said.

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Anxiety Or Depression Common Among Aging Adult Americans With Arthritis

Main Category: Arthritis / Rheumatology
Also Included In: Depression;  Anxiety / Stress
Article Date: 30 Apr 2012 – 2:00 PDT

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Researchers from the Centers for Disease Control and Prevention (CDC) found that one-third of U.S. adults with arthritis, 45 years and older, report having anxiety or depression. According to findings that appear today, April 30th, in Arthritis Care Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR), anxiety is nearly twice as common as depression among people with arthritis, despite more clinical focus on the latter mental health condition.

In the U.S. 27 million individuals, 25 years of age and older, have doctor diagnosed osteoarthritis (OA) and 1.3 adults have rheumatoid arthritis (RA) according to prevalence data from the ACR. The CDC estimates that all forms of arthritis affect 50 million Americans and is the leading cause of disability nationwide. Previous studies have reported depression is common among those with chronic illnesses such as arthritis. However, experts suggest that anxiety is often under-recognized and under-treated, and until recently was overlooked as a potential risk factor for depression.

The present study, led by Dr. Louise Murphy with the Arthritis Program at the CDC in Atlanta, Ga., selected individuals who were previous responders to the CDC’s Arthritis Conditions and Health Effects Survey – a representative population of U.S. adults 45 years or older with arthritis symptoms. Researchers identified 1,793 participants with doctor-diagnosed arthritis or other rheumatic conditions. Anxiety and depression were assessed using the emotional wellbeing questions from the Arthritis Impact Measurement Scales.

Results reveal that anxiety was more common than depression in this population at 31% and 18%, respectively. Moreover, one-third of respondents reported at least one of the two conditions, and 84% of those with depression also had anxiety. Researchers did not uncover a specific profile of characteristics for those with either mental health condition. However, only half of participants with anxiety or depression arthritis sought mental health treatment in the prior year.

“Given their high prevalence and the effective treatment options that are available, we suggest that all people with arthritis be screened for anxiety and depression,” said Dr. Murphy. “With so many arthritis patients not seeking mental health treatment, health care providers are missing an intervention opportunity that could improve the quality of life for those with arthritis.”

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Rise In Rheumatoid Arthritis Among Women Fueled By Obesity Epidemic

Main Category: Arthritis / Rheumatology
Also Included In: Women’s Health / Gynecology;  Obesity / Weight Loss / Fitness
Article Date: 28 Apr 2012 – 0:00 PDT

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Obesity and the painful autoimmune disorder rheumatoid arthritis are each becoming more common, raising a logical question: Could one have something to do with the other? For women, it appears there is a link, Mayo Clinic researchers say. They studied hundreds of patients and found a history of obesity puts women at significant risk of developing rheumatoid arthritis. Their findings are published online in the American College of Rheumatology journal Arthritis Care Research.

In rheumatoid arthritis, the immune system attacks tissues, inflaming joints and sometimes also affecting other organs and causing fever and fatigue. Rheumatoid arthritis tends to initially impact the hands and feet and then spread to the knees, ankles, hips and shoulders. It is more common in women than in men. Complications can include heart problems, lung disease, osteoporosis and carpal tunnel syndrome.

To examine a potential link with obesity, researchers pulled medical records covering 1980-2007 from the Rochester Epidemiology Project and studied 813 adults with rheumatoid arthritis and 813 adults as the control group, matched by age, gender and calendar year. Height, weight and smoking status also were noted; roughly 30 percent of the patients in each group were obese and 68 percent were women.

Rheumatoid arthritis cases rose by 9.2 per 100,000 women from 1985-2007, the study found. Obesity accounted for 52 percent of the increase. Smoking also is a substantial risk factor for developing rheumatoid arthritis, but smoking’s prevalence remained constant over the years studied, ruling it out as an explanation for the rise in rheumatoid arthritis, the study found.

More research is needed to determine how obesity may lead to rheumatoid arthritis. The exact nature of the link between obesity and autoimmune diseases such as rheumatoid arthritis is not clear, says co-author Eric Matteson, M.D., chair of the Division of Rheumatology at Mayo Clinic in Rochester.

“We know that fat tissues and cells produce substances that are active in inflammation and immunity. We know too that obesity is related to many other health problems such as heart disease and diabetes, and now perhaps to autoimmunity,” Dr. Matteson says. “It adds another reason to reduce and prevent obesity in the general population.”

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Stendra (Avanafil) For Erectile Dysfunction Approved By FDA

It is estimated that there are approximately 30 million males in the USA who suffer from erectile dysfunction.

Stendra is a medication that is taken, when needed, 30 minutes before starting sexual activity. Doctors are advised to prescribe the lowest dose at which benefit is provided for the patients.

Victoria Kusiak, M.D., deputy director of the Office of Drug Evaluation III in the FDA’s Center for Drug Evaluation and Research, said:

“This approval expands the available treatment options to men experiencing erectile dysfunction, and enables patients, in consultation with their doctor, to choose the most appropriate treatment for their needs.”

Stendra is a PDE5 (phosphodiesterase type 5) inhibitor, and increases blood flow to the penis. Patients taking nitrates should not be given this medication, the FDA emphasizes. Nitrates are often used to treat angina – combining Stendra with nitrates can bring about a sudden and severe drop in blood pressure.

In very rare cases, patients taking PDE5 inhibitors may experience color vision changes. On rarer occasions, patients may report sudden vision loss in one eye (and sometimes both). Some patients have reported loss of hearing, or decreased hearing. If you experience a sudden loss of hearing or vision you should cease taking any kind of PDE5 inhibitor, and see your doctor immediately.

The following side effects were reported by some patients during human studies: nasal congestion, common-cold symptoms, back pain, face redness, and headache. In rare cases patients may experience priapism – an erection that lasts for hours; in such cases medical help should be sought immediately.

The FDA reviewed three double-blind, placebo-controlled human studies, involving 1,267 patients who were randomly selected to take either Stendra for up to 12 weeks (50, 100 or 200 mg doses), or a placebo, up to 12 weeks, as needed, 30 minutes before sex.

Patients completed questionnaires when the study started, and then every four weeks. The questionnaires asked about erectile function, vaginal penetration, and successful intercourse. In all three studies, a considerably higher number of patients scored well on all three points, compared to those on placebo.

Stendra is marketed by Vivus Inc., Mountain View, California, USA.

Written by Christian Nordqvist

Copyright: Medical News Today

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5 Key Practices That Lead To Successful Hospital-To-Home Transitions

Main Category: Public Health
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 26 Apr 2012 – 0:00 PDT

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Community health plans are improving how patients transition from hospital to home by breaking down silos of care, coordinating among providers, and directly engaging with patients, according to a new report entitled Transitions of Care from Hospital to Home. In the report, prepared by Avalere Health for the Alliance of Community Health Plans (ACHP), Avalere researchers examined ACHP community health plans and found five practices that the plans identified as facilitating the success of their care transitions programs:

  • Using data to tailor care transition programs to patients’ needs. By identifying patients most at risk for readmission, plans can ensure that these patients get the necessary help and resources for their transition to home.
  • Anticipating patients’ needs and engaging them early in the transition process. Engaging patients prior to hospital discharge allows health plans to make sure the patient is going to an appropriate setting, prepares a patient for a home visit from a case manager or other clinician, and provides the patient with realistic expectations about their care and guidance on addressing issues that may arise.
  • Engaging providers to become program partners. Health plans can incorporate provider feedback into the design of care transitions programs and communicate regularly with provider teams to maintain physician engagement and incentivize positive outcomes.
  • Leveraging technology to improve care transitions. Technology, including access to a centralized and accurate patient record, plays a critical role in how health plans facilitate communication between patients and their providers during a transition of care.
  • Incorporating care transitions into broader quality initiatives. Some plans use their care transitions programs to enroll members into other programs such as disease management, while other plans make care transitions a component of a larger program, such as a patient-centered medical home, rather than a stand-alone initiative.

“With the increased use of quality based payments, health plans and providers have shared incentives to improve the quality of care delivered to patients,” said Dan Mendelson, CEO and founder of Avalere Health. “Our study illustrated that community health plans have taken on this charge to improve care transitions to better manage post-acute care and reduce disruptive re-hospitalizations.”

A 2009 study published in the New England Journal of Medicine found that nearly one in five Medicare patients discharged from a hospital is readmitted within 30 days, leading to high costs of care, poor quality, and low patient satisfaction. In addition, according to the Department of Health and Human Services, one in five patients discharged from the hospital to home experiences an adverse event – or harm resulting from medical care – within three weeks of discharge. By managing transitions, health plans can ensure timely follow-up care, instruct patients on proper use of medications, and reduce preventable hospital readmissions.

“We must move beyond thinking about care as individual episodes of service where one piece of the delivery system hands off a patient to another,” said ACHP President and CEO Patricia Smith. “Successful care transitions require a patient-centered approach in which providers and health plan staff are working in partnership and utilizing their unique roles and skills to provide the best care for patients.”

The new Avalere report notes patient satisfaction surveys conducted by the plans that showed care transition programs are viewed positively by patients. For example, Geisinger Health Plan, an ACHP member, uses case managers to assist patients with referrals and facilitate communication between physicians and patients. Ninety-nine percent of patients surveyed rated these services as “very good” or “good.” Ninety-six percent of surveyed patients enrolled in UPMC Health Plan’s care transitions program were either “satisfied” or “very satisfied” with the plan’s program, which uses a patient-centric care management documentation system that provides one system for all care managers to use when coordinating the care of the patient.

Additionally, Avalere found that plans featured within its report credit their care transitions programs with reducing readmission rates and decreasing costs. ACHP member HealthPartners reduced its readmission rate from 10.1 to 8.6 percent in a year for patients in its Inpatient Case Management Program. Presbyterian Health Plan estimated that its care transitions program saved approximately $1.8 million in 2010 as a result of reduced readmissions.

ACHP commissioned the report as the second in a new series, Health Plan Innovations in Patient-Centered Care. This series fills a gap in the literature on the role of health plans in delivering high-value care. Transitions of Care from Hospital to Home was developed to help other health plans build on ACHP plans’ years of experience, and lessons learned, when designing or transforming their own care transitions programs.

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THE MEDICAL SPECIALISTS’ REFERENCE

MSR will be available in three formats:

FIRST FORMAT: PRINTED EDITION

Two-volume hard copy annual edition to be released  on May 2012 during PAMS’s mid-year convention:

MSR Vol. 1, Pharmaceuticals

-color-coded guide to branded and generic  names of ethical drugs, both prescription and OTC.

MSR Vol. 2 first section, Nutraceuticals: Food Supplements and Beverages

-oral nutraceuticals like slimming and weight-loss aids, food supplements, energy drinks, and other non-therapeutic products.

MSR Vol. 2 second section, Nutraceuticals: External Applications

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MSR Vol. 2 will also include Medical Directories

-directories of PAMS members, medical/healthcare companies, hospitals, HMOs, specialty clinics and suppliers of medical equipment.

MSR will be available in three formats:

SECOND FORMAT: ONLINE EDITION

Monthly online edition, formatted as a health and wellness magazine:  www.msr.com.ph

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– together with a weekly e-newsletter  entitled “espesyalista” to be emailed to PAMS members and other subscribers to the online magazine.

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Bartonella Infection Associated With Rheumatoid Illnesses In Humans

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Arthritis / Rheumatology;  Veterinary
Article Date: 25 Apr 2012 – 1:00 PDT

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A bacterium historically associated with cat scratch fever and transmitted predominately by fleas may also play a role in human rheumatoid illnesses such as arthritis, according to new research from North Carolina State University.

Bartonella is a bacterium that is maintained in nature by fleas, ticks and other biting insects. It can be transmitted to humans both by these parasites as well as by bites or scratches from infected cats and dogs. The most commonly known Bartonella-related illness is cat scratch disease, caused by B. henselae, a species of Bartonella that can be carried in a cat’s blood for months to years.

In collaboration with Dr. Robert Mozayeni, a rheumatologist based in Maryland, and Dr. Ricardo Maggi, a research assistant professor at NC State, Dr. Ed Breitschwerdt, professor of internal medicine at NC State’s College of Veterinary Medicine and adjunct professor of medicine at Duke University, tested blood samples from 296 patients for evidence of Bartonella infection. The patients had previously been diagnosed with conditions ranging from Lyme disease to arthritis to chronic fatigue. Since rheumatic symptoms have sometimes been reported following cat scratch disease, the researchers wanted to see if these patients tested positive for B. henselae.

Of the 296 patients, 62 percent had Bartonella antibodies, which supported prior exposure to these bacteria. Bacterial DNA was found in 41 percent of patient samples, allowing investigators to narrow the species of Bartonella present, with B. henselae, B. kohlerae and B. vinsonii subsp. berkhoffii the most prevalent. The study appears in Emerging Infectious Diseases.

“Based upon this one study we can’t definitively say that a subset of rheumatoid illnesses have an infectious origin,” Breitschwerdt says. “However, our results thus far do implicate Bartonella as a factor in at least some cases. If the link between Bartonella and rheumatoid illnesses is valid, it may also open up more directed treatment options for patients with rheumatoid illnesses.”


Abstract: “Bartonella spp. Bacteremia and Rheumatic Symptoms in Patients from Lyme Disease-endemic Region”

Bartonella spp. infection has been reported in association with an expanding spectrum of symptoms and lesions. Among 296 patients examined by a rheumatologist, prevalence of antibodies against Bartonella henselae, B. koehlerae, or B. vinsonii subsp. berkhoffii (185 [62%]) and Bartonella spp. bacteremia (122 [41.1%]) was high. Conditions diagnosed before referral included Lyme disease (46.6%), arthralgia/arthritis (20.6%), chronic fatigue (19.6%), and fibromyalgia (6.1%). B. henselae bacteremia was significantly associated with prior referral to a neurologist, most often for blurred vision, subcortical neurologic deficits, or numbness in the extremities, whereas B. koehlerae bacteremia was associated with examination by an infectious disease physician. This cross-sectional study cannot establish a causal link between Bartonella spp. infection and the high frequency of neurologic symptoms, myalgia, joint pain, or progressive arthropathy in this population; however, the contribution of Bartonella spp. infection, if any, to these symptoms should be systematically investigated.

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